GW1-2022-05191_Well Construction - GW1_20220531

WELL CONSTRUCTIONRECORD Toirtrum-fluse-ON.LY:
This form on bcvwd.rbrrsinglc or multift swits-
1',Well.6muctorhiforntapion:
M AVAUR ZONES
Chris Ruffer FRONT;
4223 A rG ft.
NCWcll C6rr=1orCcr1ifiaati6oN1in66r 15.OUTER CASING fi TOR LINER f.aL)j licable)
,
-FRONT. I TO,
SARDACCO Inc
Coiqany.Namc 16.INNER CASING OR TVBING*.,wthL!rjnal cksed4oap)
YRONT TO DBINIFTER. nw"M I ATATEMAL
0 ft. 82 ft.- 1 1#- Sch 40 _iVC
110 411,qK;11rakf,'—?1F6WA 0--a. I!-lcdcn err.:)' It. ft.
3r Well,1130C 69p),
water sullpty, FRONT I To I I)t,%ATF.TFR I STOTSIZF THICKNTSN' I NYATrmm,
ClApticultural ONItitt,ic.ipa.ITubl ic 62 It-- 92 (11"1 1 iR .1 olo Seih 46 1 PVC
C360othennal(HeatingtCooiing,Stq)pjy) MRgsidLnt1a1'Wmr Supply(shigle) ft-
l31ndusWaVCdntnicrcj5I MRiesideritial NVater Supply(sbamd) 18:GROUT
FRONT_� TO. MATERIAL- FNIPLACIN MNTIN17MOT)Q XHOUNT
EllrfiOtian 0 ft.' 76 (L Portland Tremei
Non-MlawrSupply-W H: ft. IL
;1 1
tttjection Welt:: ft. (LI
MAquiIerRcqhirg6 GoGronlidsi Itcr ReRickation 19.SAND.1GR,%VEL PACK(it applicatile)
'FR4?hf To
QA46ikr Sloh�&aiii Rwoycl* r1salinily l3dilice
IJA4 r 14cr T-6t— 13I�t9.- Mwatct bini.n�,Ac 79 It. 92 ft. Sand 2
- - . I . r - ,6-
nl vpcimcintil TcqhnotPfW. QS65idcnce ConitTol 20.DRILLING LOG 641ach ad4litiooalshkxls if necessan0
El cklo the nua I(f,I o!4 Lao 0 oTricer FRONT TO I DESCRIPTION
EiGeodrennat ffleatinigCaofiog Mum) 00ther(explain ander.#21 Retuallm)
4.hite,%11 1poinpleled: 3-30-2022 %VeljI]D#PW-41 r
See Cfip s notest,
5a.,-Will I-Anzatiow -3 2022
ft. IL I
Chemours fL ft. 1nfor,-rg;,,
ficitl[ty IM(JtappiWw"C) ft, ft. ""';9 Unit
1248 Bill Hall Rd White Oak, NC 28399 Cumberland C, ft. fL
012
White Oak, NC, 28399 P15-stid oidd i
'2 L RFMARK.1,
Cumberland
llarVCI 10pqMe;j(i0i,No,(PIN)
Ikitiide and"rikkudc 6'degm 4m1fiutWie6n&or dccim�l'ftk
Ofm4ll-field,- 22.Certifienfloh:,
Ch ri5.,_ Ruffer 3-30-2022
rl orccwllislvtll Cantmeray Dale
6.Is(are)theivell(o)- MPertnaneut or oTeinpol ary.
fty,31gilbi;ihiyfurm,,l hereby rerrify rljuf the irefifs)Vivy vimutmeied iir,aeeoz&mce
kith[5,tjVCAC 02C.0100 eir EM NCX 02C0 200 Well Ciqjrifrr;CdOjl Srwaanis and Am-a
7.hi this'a repair to all cihithmg N1,ell. Mvs, mr '1KNo -copy afrhifrrcod has iem profkfM raih,.usll m0rer,
lf�0 is: rir,t,it 4.M r kni 71 i Velf f Mo a h Vp raw,i.1 GV I ffli d C'VP(a I I th e 0 h I ra re of 01 L,
at:lu aIidi;0-1,1ean Lirk%-iM&n In i-(A'll I&beak Of 6 h form. 23.Site diagranfor additional well details:
You my use ils,back of this page,to"P I rovid-e additional well site details.
etaik or liklt
8.NintiberoMeliscoustructed: constmetion:delaili wu 111ay pages if t=essajy.
Fvr walrdrpFe i*vx4m of atmi uirWe sW
TITMONS
9.Toi.il well.depth.betoiv I;Md surfkc� 92 2411. Par A.It Siibfirit this flonu uithin 36.kys pf c6niptelion of isell
10.Static water level below log of easinW.. A) filvis'Idu of Water Resources,In(mrmationl0ruiesting Unit,
Jf 1!aree kvef is fillove eds,fav;ale Id7'il[Ail'Seiff ice Center,"eigh,,NC 27699-1617
11.Borehole di2incien.6 in 010 24b.Ear DiMan Weak-ONLY: in addition to sending,IN,forni to the address in
2446o�e.also
o subtait a copy of this foun wittliti 36 days'of completion.of kvell
M Welt coustmetiouniethod. Sonic 10 ik,tono%011g::
4C.anger. dix+t p' i%etc.)
as
Division of Water Resources,Underground linjedion Contr6l Firograni;
FOR NVAT E R SUPPLY NVEL LS ONL Y.- 1636 Mill Se I rvice Center.Raleigh,NC 1 27699-163.6
131 Vidd(gpTni) NICthad of test: 2dc..Fnr Water Stipply&'Injection Welts-
Also subdiir onle Copy of,this f6flit. wtfliin 30'd of Completion of
ean I&blsinfecdou tyrper. Amount: wcIl-construction to the count),I�qltfi department oftlic countN�wficrc
to M,raw-1 Nonh Carolina Depannicut of Emirounvia and Nartual Remurces-Mkion Of NVajerReSoo­CeS Revised August 2o 13